Pediatric Primary Care Based Obesity Prevention Obesity is the number one nutritional problem in the US. Because children bear the greatest lifetime health risk from overweight and obesity, interventions targeting them are of high priority. The medical care system is an important and credible source of information about health risks and risk prevention behavior, and a large majority of children have contact with primary care medicine in the early elementary school years. Therefore, primary care based obesity interventions are particularly attractive in terms of population outreach. The present application aims to test the efficacy of brief pediatrician counseling with phone coaching follow up on rate of weight gain in children. The research extends prior work by this team on adherence, parent-child interaction, and provider and telephone based systems for treating obesity in the pediatric primary care setting. Children eligible for five through nine year well-child visits who are above the 75th percentile on BMI according to reference standards will be randomized to either: (1) Healthy Eating and Physical Activity physician message plus phone coaching; or (2) Safety and Injury Prevention physician message plus phone coaching. Participants will be followed for 2 years. The primary study outcome will be change in BMI percentile. Secondary outcomes include parental behaviors encouraging healthy eating and activity, child physical activity level, dietary intake, and child psychosocial adjustment and change in parent BMI. We will also measure program implementation cost and integrity. It is hypothesized that children in the Healthy Eating/PA group will show a smaller increase in BMI percentile relative to the children in the Safety group. It is further hypothesized that parent compliance with treatment recommendations will be associated with reductions in BMI percentile over time. The overall objective is to demonstrate the efficacy of a low-cost intervention targeting obesity prevention in children in a primary care setting with potential for widespread dissemination. PUBLIC HEALTH RELEVANCE: This randomized clinical trial will evaluate the efficacy of a primary care-based obesity prevention intervention that integrates counseling by pediatric primary care providers and a phone-based program for parents of 5-9 year old children at risk for obesity. The phone-based program will reinforce the physician message and help parents create a healthy home environment to encourage healthy eating and activity patterns and healthy weight gain in their children.